Description: (provided by the applicant) Malnutrition is a major problem among nursing home (NH) residents, with high prevalence and substantial health and financial consequences. An important contributor to malnutrition in the NH is inadequate staff to provide feeding assistance. This intervention study will refine a method for optimizing NH staff efficiency in providing feeding assistance to residents and then test the efficacy of this model in a randomized clinical trial with quality of life and health outcomes. This proposal will address this problem in two major phases. In the first phase, the efficacy and costs of providing feeding assistance to residents will be evaluated using a randomized controlled design to define the NH staff resources necessary to provide efficacious assistance. Using these results, computerized staffing simulation models will project the minimum number of nursing staff necessary to provide feeding assistance to residents for a range of environmental and resident acuity levels that characterize different homes. This phase is sufficiently powered to address the important issues of: (1) how NHs should allocate staff so as to provide feeding assistance to residents who need it; and (2) to document the effects of such assistance on food intake. However, Phase 1 is not designed to identify health or quality-of-life outcomes that may be associated with improved feeding assistance and food intake. Therefore, in the second phase, residents in two different nursing homes who are found to increase their intake with the feeding assistance intervention will be randomized into either an immediate or delayed treatment group. Research staff will maintain the efficacious feeding assistance protocols with the intervention group to detect intervention effects on body weight, quality of life, functional status, and biomedical markers of under nutrition.